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Toward Elimination of Healthcare-associated Infections: A call to Action

Categories: CLABSI, Dialysis, Healthcare-associated infections, Long Term Care (LTC), Outpatient Care

Dr. Denise Cardo

Dr. Denise Cardo

Author – Dr. Denise Cardo
Director of CDC’s Division of Healthcare Quality Promotion

Recently, partners hosting the 5th Decennial International Conference on healthcare-associated infections (HAIs) – APIC, CDC, IDSA and SHEA – along with public health and other professional organizations (CSTE, ASTHO, PIDS), called for the elimination of healthcare-associated infections (HAIs), by implementing proven public health strategies used to combat other diseases (see statement in ICHE or AJIC). This is a bold step.

Is it possible?

Scientifically, there exists a legitimate opportunity to eliminate specific HAIs, including central line-associated bloodstream infections (CLABSIs). Recent local and regional initiatives have shown 60%-70% overall decreases of CLABSIs in intensive care units (ICUs), with some locations reporting zero CLABSIs for up to four years following implementation.

Is this enough?

More needs to be done to accomplish the HHS Action Plan to Prevent HAIs and extend those successes into all healthcare settings such as outpatient surgery centers, long-term care facilities and dialysis clinics.


Elimination of HAIs depends on sustainable actions, requiring investment. These actions should include:

  • Empowering healthcare professionals with a will to succeed in this area at all levels
  • Ensuring adherence to evidence-based practices
  • Conducting research to close knowledge gaps
  • Aligning infection prevention efforts with incentives to reward excellence
  • Monitoring infect ion rates to assess progress and respond to emerging threats

Why now?

Momentum and investment at the federal, state and local levels in the prevention of HAIs, such as the HHS Action Plan to Prevent HAIs, the American Recovery and Relief Act funding, individual state mandates for public reporting, the Deficit Reduction Act, the Patient Protection and Affordable Care Act, and consumer expectations for transparency and accountability provide momentum for this success in this unique moment in time.

We count on you.

Please join us in this important call for the elimination of healthcare-associated infections. Team work in all levels of healthcare will be necessary, as are partnerships among several groups, including public health, healthcare facilities, legislators, consumers.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. March 18, 2011 at 12:12 pm ET  -   SinaZhu

    Amazing post, truly! Thanks very much!

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  2. October 15, 2010 at 2:02 pm ET  -   John Dalton, FHFMA

    Dr. Cardo makes some excellent points, but in my experience, the final two are particularly relevant:
    •Aligning infection prevention efforts with incentives to reward excellence
    •Monitoring infection rates to assess progress and respond to emerging threats

    With 40 years experience in healthcare finance, I long ago learned that what gets measured and monitored gets managed. One recurring frustration has been the inability of finance and clinicians to work together in a collaborative manner to measure quality and reduce costs. It’s sort of like the old song from “Oklahoma” that farmers and cowboys should be friends.

    Breakthroughs on this front are rare and should be celebrated. The August issue of hfm ( featured a seminal article, “Moving Quality and Cost to the Top of the Hospital Agenda,” coauthored by Dr. John Byrnes, SVP, System Quality and Joe Fifer, VP, Finance at Spectrum Health System. It described Spectrum’s successful four pronged approach that has produced enhanced revenue and cost savings resulting from quality improvement programs that total about $68 million annually. Their approach:
    • Leverages the strategic plan to support the organization’s quality and safety goals,
    • Uses “budget-like” tactics to set quality and safety goals,
    • Emulates the finance model of reporting and accountability to meet quality goals, and
    • Bases a portion of incentive compensation, salary adjustments, and annual performance reviews on the achievement of quality-related goals.

    Any healthcare professional seriously interested in eliminating HAIs will find their article illuminating. Michael Bailey also makes a valid point – when payers consistently refuse to pay for the added costs incurred in treating HAIs, improving quality will become an imperative. My preference is to reward, not punish. My own experience is that improved quality inevitably results in reduced costs. And, as the CDC has pointed out, HAIs occur in 5% of hospital admissions resulting in 99,000 associated deaths annually and add $28-33 billion to direct medical costs.

    Thanks for letting me share my thoughts. Let’s save some lives.

    John Dalton, FHFMA

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  3. October 10, 2010 at 6:57 pm ET  -   Michael E. Bailey

    The goal of eliminating all HAIs is within reach and a critical part in the process will be improving communications on the issue up-down-across organizational lines in the health care setting. Thus, eliminating the knowledge and information gaps. Health IT will be able to play an important role in improving communications on this issue as well. And I very strongly agree that incentives for medical providers to work together and develop processes for eliminating HAIs will be another critical component. One incentive could be for CMS to pay the patients medical claims doctors and hospitals submit but to deduct from payments the cost for HAIs with a requirement that doctors and hospitals cannot pass the cost for HAIs on to patients. That would be a powerful incentive for the medical community to do all it can to eliminate HAIs. We have been working here in California for the past year on the new 1115 MediCaid Waiver for CMS which has one aim of improving patient quality of care and the elimination of HAIs is a major concern at the State Department of Health Care Services and one of the things being looked at in the Waiver. Best wishes, Michael E. Bailey.

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  4. October 8, 2010 at 11:19 am ET  -   Roberta Mikles

    It is my opinion, as a dialysis patient safety advocate, that Action Plans, Initiatives and Conditions are NOT enough. More is needed and is of great necessity. In review of hundreds of facility surveys, communicating with patients, families and staff, from all over the US, visiting facilities and knowing that even with the NEW Conditions that hand washing and changing gloves is the most frequent cited deficiency definitely tells us something. Have things in units changed since the new Conditions, focused on Infection Control? Have practices changed since dialysis technicians are mandated to be certified? We are hearing from patients that nothing has changed in their units in respect to incorrect practices e.g. hand hygiene, glove changing. Well, maybe if upper management is present, but for the most part not many changes.

    In all due respect, Dr. Cardo, you let out one of the most important, if not the most important aspect. — patient involvement. Patients CAN and DO prevent mistakes including, but not limited to a preventable infection. However, this can ONLY happen if patients are fully educated, by staff, in those practices that will prevent infection. This extends FAR BEYOND telling a patient to wash their access prior to entering the treatment area. It includes explaining disinfection process to patients so they can remind staff if such is not appropriately conducted e.g. not allowing betadine to dry and wiping off while still wet, or when the patient reminds the staff that their gloves are contaminated and to change prior to cannulation. The engagement of patients is greatly lacking in many units with advocates often hearing ‘well patients do not want to be involved or educated’. This might be true for some, but there are many who want to be involved. This is HOW we can decrease infections. Also, without unit-level appropriate supervision to ensure that staff are implementing correct practices, we might not see improvement. We must start at the bottom and look at this root cause……Survey findings speak for themselves and to hear that staff are nervous when surveyors are present is just, in our thinking as advocates, another excuse. I heard a corporate level dialysis individual state to me once, ‘if staff are confident in their practices and know what they are doing and are doing that which is correct, then they should not be nervous when someone is watching’. A perfect point is the following which recently occurred — a facility was surveyed and found to not be disinfecting chairs the apporpriate way according to faciilty policy. Dried blood and debri was on chairs. After the survey team left, the staff cheered and clapped that they has passed. The staff for two or three days after the survey disinfected chairs according to facility policy, but then returned to their old habits. So, our question as advocates “Where and what kind of unit-level supervision is occurring in this unit to ensure correct practices are implemented to protect patients? This is just one of many, many similar situations.
    Until the culture in dialysis units changes so that patients can be appropriately educated (as the APIC guidelines state) and until staff openly encourage and accept patient participation and reminders without covert retaliation, the intended desire outcomes of any intitiatve might not be met. Do not fool yourself into thinking that this covert retailiation does not exist. All one staff has to do is roll their eyes, or shrug their shoulders, when a patient asks for them to wash their hands…….and, this results in the patient never again asking as he/she has been sent a clear message ‘do not ask or remind me again’.

    Roberta Mikles RN
    Dialysis Patient Safety Advocate

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  5. October 8, 2010 at 11:14 am ET  -   Tweets that mention CDC - Blogs - Safe Healthcare – Toward Elimination of Healthcare-associated Infections: A call to Action --

    [...] This post was mentioned on Twitter by RWJF QualityEquality, PRIDE Restoration. PRIDE Restoration said: CDC : Toward Elimination of Healthcare-associated Infections: A call to Action [...]

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  6. October 7, 2010 at 2:13 pm ET  -   Craig Bell

    I agree that the elimination of HAI should be the goal and all avenues explored to achieve the goal. I have previously indicated how the broad application of antimicrobial coatings to surfaces in the healthcare setting can help in reducing cross-contaminations and possibly infections. The products available have been studied in the laboratory and anecdotally in clinical and real world settings. I believe the reward of a multi-site study of these types of treatments would have great benefit to the industry.

    The processes to obtain funding for studies is a cumbersome one which limits the access to the funds for scientific studies that could be done to generate data to identify the paths to zero HAIs.

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